|
DEXAMETHASONE SODIUM PHOSPHATE, 1 MG
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
4400219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of NY Commercial |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Galaxy Health Commercial |
$0.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.20
|
| Rate for Payer: WellCare Medicare |
$0.20
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE, 1 MG
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
4400217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of NY Commercial |
$0.55
|
| Rate for Payer: Aetna of NY Medicare |
$0.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.50
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: CDPHP Commercial |
$0.81
|
| Rate for Payer: CDPHP Medicare |
$0.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.80
|
| Rate for Payer: EmblemHealth Medicaid |
$0.80
|
| Rate for Payer: EmblemHealth Medicare |
$0.34
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Fidelis Medicare |
$0.38
|
| Rate for Payer: Galaxy Health Commercial |
$0.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WellCare Medicare |
$0.55
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE, 1 MG
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
4400219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of NY Commercial |
$0.20
|
| Rate for Payer: Aetna of NY Medicare |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.18
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: CDPHP Commercial |
$0.29
|
| Rate for Payer: CDPHP Medicare |
$0.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.29
|
| Rate for Payer: EmblemHealth Medicaid |
$0.29
|
| Rate for Payer: EmblemHealth Medicare |
$0.12
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Fidelis Medicare |
$0.14
|
| Rate for Payer: Galaxy Health Commercial |
$0.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.13
|
| Rate for Payer: Humana Medicare |
$0.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WellCare Medicare |
$0.20
|
|
|
DEXA-VERTEBRAL FRACTURE ASSES
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 77086
|
| Hospital Charge Code |
4150313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
DEXA-VERTEBRAL FRACTURE ASSES
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 77086
|
| Hospital Charge Code |
4150313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: EmblemHealth Select Care |
$169.00
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$86.58
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
DEXTROSE 0.4 GEL 3X37.5GM
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00574007015
|
| Hospital Charge Code |
4400334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna of NY Commercial |
$8.47
|
| Rate for Payer: Aetna of NY Medicare |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.05
|
| Rate for Payer: Cash Price |
$9.08
|
| Rate for Payer: CDPHP Commercial |
$9.74
|
| Rate for Payer: CDPHP Medicare |
$4.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.68
|
| Rate for Payer: EmblemHealth Medicaid |
$9.68
|
| Rate for Payer: EmblemHealth Medicare |
$4.11
|
| Rate for Payer: EmblemHealth Select Care |
$8.71
|
| Rate for Payer: Fidelis Medicare |
$4.61
|
| Rate for Payer: Galaxy Health Commercial |
$7.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.48
|
| Rate for Payer: Humana Medicare |
$4.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.08
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.70
|
| Rate for Payer: United Healthcare Medicare |
$4.48
|
| Rate for Payer: WellCare Medicare |
$6.66
|
|
|
DEXTROSE 0.4 GEL 3X37.5GM
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 00574007015
|
| Hospital Charge Code |
4400334
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Cash Price |
$9.08
|
| Rate for Payer: Galaxy Health Commercial |
$7.86
|
| Rate for Payer: WellCare Medicare |
$6.66
|
|
|
DEXTROSE 10%-WATER IV SOLUTION 250 mL
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
4401427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
DEXTROSE 10%-WATER IV SOLUTION 250 mL
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
4401427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$5.76
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
DEXTROSE 10%-WATER IV SOLUTION 500 mL, 500 mL
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00264752010
|
| Hospital Charge Code |
4401373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$5.60
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$5.76
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
DEXTROSE 10%-WATER IV SOLUTION 500 mL, 500 mL
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00264752010
|
| Hospital Charge Code |
4401373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
DEXTROSE 25%/WATER 0.25 ANSY 10X10ML
|
Facility
|
IP
|
$27.04
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
4400221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
DEXTROSE 25%/WATER 0.25 ANSY 10X10ML
|
Facility
|
OP
|
$27.04
|
|
|
Service Code
|
NDC 00409177510
|
| Hospital Charge Code |
4400221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna of NY Commercial |
$18.93
|
| Rate for Payer: Aetna of NY Medicare |
$12.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.52
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: CDPHP Commercial |
$21.77
|
| Rate for Payer: CDPHP Medicare |
$10.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.63
|
| Rate for Payer: EmblemHealth Medicaid |
$21.63
|
| Rate for Payer: EmblemHealth Medicare |
$9.19
|
| Rate for Payer: EmblemHealth Select Care |
$19.47
|
| Rate for Payer: Fidelis Medicare |
$10.30
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.28
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$10.00
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
DEXTROSE 50%/WATER 0.5 ANSY 10X50ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
4400222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
DEXTROSE 50%/WATER 0.5 ANSY 10X50ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00409751716
|
| Hospital Charge Code |
4400222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
DEXTROSE 50%/WATER 0.5 LSSY 10X50ML
|
Facility
|
OP
|
$29.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: Aetna of NY Commercial |
$16.29
|
| Rate for Payer: Aetna of NY Medicare |
$13.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.80
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: CDPHP Commercial |
$23.84
|
| Rate for Payer: CDPHP Medicare |
$10.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.69
|
| Rate for Payer: EmblemHealth Medicaid |
$23.69
|
| Rate for Payer: EmblemHealth Medicare |
$10.07
|
| Rate for Payer: EmblemHealth Select Care |
$21.32
|
| Rate for Payer: Fidelis Medicare |
$11.28
|
| Rate for Payer: Galaxy Health Commercial |
$19.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.96
|
| Rate for Payer: Humana Medicare |
$10.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.29
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.21
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.50
|
| Rate for Payer: United Healthcare Medicare |
$10.96
|
| Rate for Payer: WellCare Medicare |
$16.29
|
|
|
DEXTROSE 50%/WATER 0.5 LSSY 10X50ML
|
Facility
|
IP
|
$29.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Aetna of NY Commercial |
$16.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.32
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Galaxy Health Commercial |
$19.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.29
|
| Rate for Payer: WellCare Medicare |
$16.29
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 77066 TC
|
| Hospital Charge Code |
4150401
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$389.35 |
| Max. Negotiated Rate |
$389.35 |
| Rate for Payer: Cash Price |
$449.25
|
| Rate for Payer: Galaxy Health Commercial |
$389.35
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 77066 TC
|
| Hospital Charge Code |
4150401
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$203.66 |
| Max. Negotiated Rate |
$482.20 |
| Rate for Payer: Aetna of NY Commercial |
$419.30
|
| Rate for Payer: Aetna of NY Medicare |
$275.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$449.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$449.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$221.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$299.50
|
| Rate for Payer: Cash Price |
$449.25
|
| Rate for Payer: Cash Price |
$449.25
|
| Rate for Payer: CDPHP Commercial |
$482.20
|
| Rate for Payer: CDPHP Medicare |
$221.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$419.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$479.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$479.20
|
| Rate for Payer: EmblemHealth Medicaid |
$479.20
|
| Rate for Payer: EmblemHealth Medicare |
$203.66
|
| Rate for Payer: EmblemHealth Select Care |
$389.35
|
| Rate for Payer: Fidelis Medicare |
$228.28
|
| Rate for Payer: Galaxy Health Commercial |
$389.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$221.63
|
| Rate for Payer: Humana Medicare |
$221.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$419.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$275.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$449.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$337.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$232.71
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$221.63
|
| Rate for Payer: WellCare Medicare |
$329.45
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 77065 TC
|
| Hospital Charge Code |
4150400
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$332.50
|
| Rate for Payer: Aetna of NY Medicare |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$175.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$237.50
|
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: CDPHP Commercial |
$382.38
|
| Rate for Payer: CDPHP Medicare |
$175.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$332.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$380.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$380.00
|
| Rate for Payer: EmblemHealth Medicaid |
$380.00
|
| Rate for Payer: EmblemHealth Medicare |
$161.50
|
| Rate for Payer: EmblemHealth Select Care |
$308.75
|
| Rate for Payer: Fidelis Medicare |
$181.02
|
| Rate for Payer: Galaxy Health Commercial |
$308.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$175.75
|
| Rate for Payer: Humana Medicare |
$175.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$332.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$267.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$184.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$175.75
|
| Rate for Payer: WellCare Medicare |
$261.25
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 77065 TC
|
| Hospital Charge Code |
4150400
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: Galaxy Health Commercial |
$308.75
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI, LEFT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 77065 LT,TC
|
| Hospital Charge Code |
4150409
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$332.50
|
| Rate for Payer: Aetna of NY Medicare |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$175.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$237.50
|
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: CDPHP Commercial |
$382.38
|
| Rate for Payer: CDPHP Medicare |
$175.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$332.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$380.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$380.00
|
| Rate for Payer: EmblemHealth Medicaid |
$380.00
|
| Rate for Payer: EmblemHealth Medicare |
$161.50
|
| Rate for Payer: EmblemHealth Select Care |
$308.75
|
| Rate for Payer: Fidelis Medicare |
$181.02
|
| Rate for Payer: Galaxy Health Commercial |
$308.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$175.75
|
| Rate for Payer: Humana Medicare |
$175.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$332.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$267.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$184.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$175.75
|
| Rate for Payer: WellCare Medicare |
$261.25
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI, LEFT
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 77065 LT,TC
|
| Hospital Charge Code |
4150409
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: Galaxy Health Commercial |
$308.75
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI, RIGHT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 77065 RT,TC
|
| Hospital Charge Code |
4150408
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of NY Commercial |
$332.50
|
| Rate for Payer: Aetna of NY Medicare |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$175.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$237.50
|
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: CDPHP Commercial |
$382.38
|
| Rate for Payer: CDPHP Medicare |
$175.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$332.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$380.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$380.00
|
| Rate for Payer: EmblemHealth Medicaid |
$380.00
|
| Rate for Payer: EmblemHealth Medicare |
$161.50
|
| Rate for Payer: EmblemHealth Select Care |
$308.75
|
| Rate for Payer: Fidelis Medicare |
$181.02
|
| Rate for Payer: Galaxy Health Commercial |
$308.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$175.75
|
| Rate for Payer: Humana Medicare |
$175.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$332.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$267.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$184.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$175.75
|
| Rate for Payer: WellCare Medicare |
$261.25
|
|
|
DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI, RIGHT
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 77065 RT,TC
|
| Hospital Charge Code |
4150408
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$356.25
|
| Rate for Payer: Galaxy Health Commercial |
$308.75
|
|
